Cultures are an integral part of a person’s life, and they influence an individual’s social and cognitive development. They can contribute to the onset, perpetuation and outcomes of many psychiatric illnesses. These have a major role in defining abnormal behaviours and deviance, but cultures can also heavily influence pathways to care by influencing explanatory models and resources. In addition, culture moulds an individual’s worldview. Cultures are incipient, with institutions of education, employment and training having their own microcultures. Individuals learn to navigate these multiple cultural and micro-identities in order to achieve their aims. The relationship between the culture and prevalence of various psychiatric disorders is complex. In recent times, for political and economic reasons, attitudes towards economic migrants as well as refugees and asylum seekers appear to have become more negative in high-income countries. Hence, it is important to recognise that cultures have relativist characteristics rather than universalist, though some features may be common in designing, developing and delivering services. The role of culture in mental illness is described in this chapter.

This chapter presents a revised, annotated translation of Arrian’s published version of his report to the emperor Hadrian (written around AD 131–5, when his consulship was long past) about his tour of duty in the Black Sea, when he led a squadron of ships from Trapezous round the east end of the sea as far as Dioskourias-Sebastopolis. The text mentions several Roman military installations and outlines the geopolitical circumstances of particular districts, as well as listing many harbour and river mouths together with the distances between them. The southern shore of the sea is described in a ‘flashback’, while the north-western and western parts, which Arrian did not reach, are described on the basis of earlier reports. As the chapter introduction points out, the digression near the end of the work about the island of Leuke (mod. Zmiinyi), where Achilles lived after being spirited away from Troy, is thought to be a tacit tribute to Hadrian’s companion Antinoös, who had died in 130. A new map illustrates the stages of the narrative.

This chapter details the epidemiology, route of spread, symptoms, diagnosis, treatment, prophylaxis and infection control relating to viruses causing hepatitis (HAV, HBV, HCV, HDV, HEV, CMV, EBV and arboviruses).

Civil unrest or terrorism at mass gathering events can erupt with significant violence and multiple casualties. These are high-risk situations, not only because of physical casualties, but also because of ethical, political and psychological sequelae. Beyond specialized planning, multi-agency drills and proficient tactical medicine training, medical teams should co-create secured access and egress, alternative medical responses and rapidly-adapting coordination and secure communications with other agencies. Civil protests can escalate, especially when extremist groups infiltrate them. Multi-site violence and assaults can evolve, particularly in terroristic attacks. Key lessons include unrelenting vigilance until all participants have left the mass gathering scene in its entirety. Violence (bombs, shootings, vehicle attacks) will often erupt when mass gatherings are dispersing and considered over. Terrorists can also purposely target medical personnel or incite one event (fire, bomb, shooting) to create crushing stampedes or to herd crowds into more vulnerable areas where they can be further attacked more directly with other modern weapons. Terrorists often attack from elevated perches or generate “protracted suicide” incidents while holding hostages, including many severely-wounded. The resulting frustration, anger and guilt commonly can consume medical rescuers when beholding slaughtered innocents or simply because they were (appropriately) staged during containment of on-going violence.

Victorian MPs debated whether or not the Inns of Court adequately governed the bar and effectively trained their members. The societies defended themselves from parliamentary assaults by insisting that legal etiquette ensured the gentlemanly character of the bar. This chapter examines disciplinary hearings for violations of etiquette at the Inns to consider the societies’ direct assertions of their authority over the operations of the legal profession. In the nineteenth century, breaches of legal etiquette largely pertained to ungentlemanly behavior, such as engaging in trade. In the geopolitical context of the early twentieth century, however, faced with members holding new radical political commitments, the societies overlaid concerns about gentlemanliness with worries over personal political expression and national loyalty. The societies manipulated legal etiquette to deliberately excuse or disbar members for similar offenses along lines that accorded more with members’ seeming Britishness or foreignness than with the legality or illegality of their actions.

How fast or slow does the process of dysregulating the stress response system go before a disease emerges? This chapter builds a model for how this process works over the lifespan. The apparently sudden onset of diabetes or heart disease in our fifties or sixties can often be traced to dysregulations that began years or decades before, invisible to the unsuspecting and asymptomatic. Toxic stress accelerates illness and speeds up aging. How do we know if we’re on a fast track to future illness and early death? And when is the best time to intervene? That depends on how we measure stress. Consider Teresa Langford’s pathways from genes to stress to illness over 53 years.

Weather plays a major role in the safe execution of mass gathering events (MGE). It poses notable health-related challenges due to forecasting reliability and relative unpredictability, but risks can be mitigated with thoughtful planning and threat assessment, bolstered by the presence of appropriate on-scene medical resources and transport plans. Although MGE have historically been cultural and recreational events, climate change and a variety of downstream impacts have also led to nearly continuous large-scale human migration. Mobile MGE are now present at any given time throughout the world and many are amassed on nation-state borders. It is likely that this will increasingly become the norm, and lessons learned from more conventional MGE medical responses will help meet the needs of this new frontier in mass gathering medicine.

This chapter presents new, annotated translations of the principal testimonia and fragments of Skylax of Karyanda (late 6th century BC), arranged as fourteen extracts. Skylax, we are told by Herodotos, was recruited by King Darius of Persia to explore the Indus. The chapter introduction assesses recent studies that trace the echoes of his travel narrative in Philostratos’ Life of Apollonios (3rd century AD) and suggest that Skylax descended the Ganges to the east coast of India, perhaps voyaging as far as Taprobane (Sri Lanka). A specially drawn map indicates the area within which he most likely travelled.

Mass gatherings create challenges for timely and efficient medical response. Compounded by exceptional noise from cheering crowds and ambient entertainment, compacted audiences form predictable barriers to patient sightings and access. Timely access also may be complicated by steep arena stairwells or poorly-defined locations along a longitudinal raceway, parade, or beachside festival. On-scene responders often encounter fixed barricades, inebriated crowds, obtrusive noise, and relative distances from on-site medical aid centers. Very often, potentially ill or injured persons are adamantly set against leaving their coveted position in the audience having purchased expensive tickets, traveled far and awaited many months, or even years, to be there. Once retrieved, patients need to be conveyed with protective measures and evaluated appropriately despite resource-limited settings and often pervasive heat, humidity and intoxication. Accordingly, patient identification, intra-site retrieval, evacuation, tracking, and communications need to be optimally planned and well-coordinated to mitigate these challenges. Recent experiences have provided evolving insights into best practices for mass gathering medical professionals. Many are addressed within this discussion including definitions for reportable patients, use of spotters and geospatial applications, coordinated tandem response with security personnel, dedicated record-keepers at medical care sites and electronic tracking devices for vulnerable populations and even entire audiences.

Gestures associated with negation have become a well-defined area for gesture studies research. The chapter offers an overview of this area, identifies distinct empirical lines of enquiry, and highlights their contribution to aspects of linguistic and embodiment theory. After relating a surge of interest in this topic to the notion of recurrent gestures (but not restricted to it), the chapter offers a visualization of the widespread geographical coverage of studies of gestures associated with negation, then distils a set of common observations concerning the form, organizational properties, and functions of such gestures. This area of research is then further thematized by exploring distinct chains of studies that have adopted linguistic, cognitive-semantic, functional, psycholinguistic, comparative, and cultural perspectives to analyze the gestural expression of negation. Studies of gestures associated with negation are shown to have played a vital role in shaping understandings of the multimodality of grammar, the embodiment of cognition, and the relations between gestures and sign.

Lawsuits for medical negligence and personal injury are a fact of life in the health care profession. Participation as a clinician at a mass gathering event, whether as an independently paid clinician, as an employee of a medical group, as an operational medical director or as simply a volunteer all create liability risks. Liability risks decrease the further the provider is removed from direct care of the patient, and in certain situations (e.g., volunteer Good Samaritan, Operational Medical Director) the risks of individual liability are quite low or may be obviated by statutory immunities. That fact notwithstanding it is incumbent upon providers to act reasonably and to be sure to comply with standard risk management practices such as thorough, contemporaneous documentation, obtaining consent when reasonable, and respecting patient privacy as required by HIPAA. Finally, since exercising all reasonable risk management efforts cannot always prevent a lawsuit, liability insurance protection is critical, to cover providers both from lawsuits over direct care and lawsuits over administrative decision-making. Even with a spurious case there are significant legal costs and expenses.

This chapter details the epidemiology, route of spread, prevalence, incubation period and at-risk groups relating to human adenoviruses. It gives information on symptoms, laboratory diagnosis, treatment, prophylaxis and infection control.

Part of the intellectual intrigue for many people who choose a career in mental health is the challenge of reading between the clinical lines and sussing out information that transcends the obvious. Do patients’ words and behaviors align? Are subjective symptoms consistent with overt functioning? Does a clinical narrative conform to a set of circumstances? How does a clinician know when someone is lying, concealing key information, embellishing facts, or otherwise operating with an agenda? Or what if the patient has no vocabulary for accurately communicating their internal experience, and it is left to the clinician to deduce what may actually be happening for them internally? A clinician’s ability to recognize the unspoken parameters of psychiatric communication pertains to many if not most forms of mental illness, either by intention or happenstance, since patients themselves may not always be fully aware of what it is that they want or need. Clinical decision-making can only be as sound and logical as the quality of information made available to the decision-maker. Herein lies the challenge both for assessment and treatment planning when the patient is less than forthcoming, deceptive, confabulating, confused, denying, demented, delirious, malingering, ashamed, scared, alexithymic, misinformed, or otherwise less than a full-fledged participant in their own care.

Providing emergency services to event gatherings of any size goes far and beyond simply having medical providers present. Small events may not need a large cache of supplies or equipment, or even a medical tent to stage out of; however, as events grow, the resources required to provide effective care grows exponentially to the number of staff required. Ambulances, medical supplies, and even self-contained medical shelters are often essential to ensure a comprehensive and capable provision of services to manage any on-site emergencies. Large events necessitate extensive preplanning and support logistics in order to become self-reliant and sustainable. Establishing an effective IMT (Incident Management Team) with multiagency inclusion early in the planning process allows the designation of roles, responsibilities, scope, and associated logistics. As events expand, being able to provide care requires the incorporation of complex algorithms of operations and careful pre-event acquisition of everything from Band-Aids and OTC (over the counter) medications to ACLS standard medications and critical care equipment to compliment capability. Setting up a “base of operations” will allow coordination of a hospital-like treatment area, a command tent/trailer, stretchers, equipment, personnel, and supplies to support the extended events.

In Chapter 5, on Yeats’s series of plays about the legendary warrior Cuchulain, I return to the early period to take up a thread of Yeats’s development as a dramatist in order to illustrate a crucial aspect of his worldmaking project. The legendary world that he envisioned in this series evolved out of his need to overcome the intransmissibility of indigenous Irish culture in anything like an original or authentic form, a problem that Yeats confronted when he considered the role of folklore and legend in a national literature. The plays are also well suited, by virtue of the temporal extension of the series – from the first production of On Baile’s Strand (1904) to the composition of The Death of Cuchulain (1939) – to convey Yeats’s developing sense of personality and the ethics of heroism. By transposing the heroic world of Cuchulain, particularly as described by Standish O’Grady and Augusta Gregory, to the contemporary stage, Yeats does not revive the past in the interests of preserving it in amber. His task, like that of the literary revival at large, was not just to express the vitality of the past and its ethos but to place both at the forefront of a modern national literary movement.